An integrated critique of the efficacy of topical mupirocin in preventing catheter-related Staphylococcus aureus infections in peritoneal dialysis clients.

Several epidemiological studies indicate that, for two reasons, Staphylococcus aureus (SA) nasal carriage is a risk factor for developing SA infections in peritoneal dialysis (PD) clients. First, nasal carriage is prevalent in these clients due to the nature of their disease. Second, there is a significant relationship between nasal and hand carriage of the SA organism. Because PD clients require frequent catheter handling to receive therapy, they are at risk for catheter contamination. Two prospective randomized control trials and two prospective cohort trials with historical controls were selected for review. Emphasis was placed on the design feature of a comparison or control group in order to find empirical support for the efficacy of topical mupirocin (Bactroban) as an infection control measure. The four studies selected also used two methods of application, the first application was to the nares and the second was to the catheter exit site. The result of the analysis revealed a weak support for the prophylactic role of topical mupirocin in preventing SA exit-site infections (ESI) in PD clients. Well-controlled prospective, randomized studies with sufficiently large sample sizes to produce statistically and clinically significant results for the prophylactic role of mupirocin are lacking. In light of the analysis, the advocacy of several practice implications involving client education and timely follow-up, staff training, and client comfort are warranted.